| Register: Bold fields are required. | |
| Login Name | |
| First Name | |
| Last Name | |
| Address | |
| City | |
| State/Country if non-US | |
| Zip Code | |
| Phone (xxx) xxx-xxxx | |
| Hospital/Institution Name | |
| How long have you been administering the diet? | |
| How many patients have you put on the diet? | |
| How many patients per month, on average, do you start on the diet? | |
| How many patients do you currently have on the diet? | |
| Does your dietitian work exclusively on the ketogenic diet? |
Yes No |
| If not, what percentage of her/his time is used for keto kids? | |
| Do you use a computer program to calculate meal plans? |
Yes No |
| If yes, which one? | |
| Do you fast patients to initiate the diet? |
Yes No |
| What age patients are you working with? | |
| Anything else to add |